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colchicine (KOL chi seen)
What is colchicine?
This is a very old drug which is still used to treat or prevent acute gouty arthritis. The drug also may retard the formation of fibrous or collagen tissue in the body, especially the liver.
What is it used for?
Colchicine is used to treat or prevent acute gouty arthritis. In gastroenterology it may be used to slow the formation of fibrous tissue in the liver that occurs with conditions such as cirrhosis and primary biliary cirrhosis.
How do I take it?
Follow your physician’s instructions carefully. This drug may be taken on an empty stomach or with food to reduce stomach irritation. Tablets may be crushed and sprinkled on food. Keep all medications away from children. Never share your medications with anyone else.
What do I do for a missed dose?
If you miss a dose of this medicine, take it as soon as possible. If it is almost time for the next dose, skip the missed dose and return to your regular schedule. Do not double up on this medication.
Are there interactions with food or beverages?
Drink plenty of fluids (at least 3 quarts) every day. Colchicine can be taken with milk. Avoid herbal teas that are promoted as beneficial for arthritis. Caffeine (coffee, tea, cola, chocolate) decreases the drug’s effect. There is no interaction with alcohol. However, alcohol increases the risk of GI irritation and bleeding and also raises uric acid levels which could interfere with gout management.
Are there interactions with other drugs?
An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction.
Interactions with this drug may occur with the following:
- cyclosporine (Neoral, Sandimmune)
- erythromycin (E-Mycin, Eryc)
Is there a problem if I have another disorder or disease?
At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease. Patients with advanced kidney or liver disease or chronic muscle (myopathy) or nerve (neuropathy) disorders should discuss its use with their physician. Since the drug may prevent the absorption of vitamin B12 from the small intestine, those patients with a vitamin B12 problem will need medical advice.
What about allergies?
People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient’s allergy history. Signs of an allergic reaction are skin rash and fever. Of course, a person should not take colchicine if there has been a previous reaction to this or a similar drug.
What if I’m pregnant, considering pregnancy or breast-feeding?
Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Colchicine is ranked C. Always consult your physician before taking any drug during or when planning pregnancy.
What are the effects on sexual function?
This drug can cause temporary male infertility. This effect is reversed when the drug is discontinued.
Are there other precautions?
Colchicine can lower body temperature, especially in the elderly. Use caution to prevent hypothermia. Consult with your physician if you are injured or develop a new illness. Such stress can bring on an acute attack of gout and it may be necessary to adjust the dosage.
How long is it safe to take colchicine?
For an acute attack, stop the drug when pain is relieved or nausea, vomiting or diarrhea occurs. Do not take more colchicine for the next 3 days without consulting your physician. For prevention, use the smallest effective dose for long-term management.
How about side effects?
Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately.
For colchicine, the following are the observed side effects:
- hair loss
- stomach pain
- abdominal cramping
- numbness or pain in hands or feet
- bloody urine
- reduced urine
- sore throat
- abnormal bleeding or bruising
- skin rash
A physician’s comment…
This drug has a long and honorable history in medicine for treating gout. It generally has been a safe drug to use. There are now other drugs that are usually better in treating gout. In gastroenterology, its role is somewhat limited.